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Personal Information
Mandatory Questions
Please give details and current status
Please give details and current status
Please give details and current status
Clinical Work Experience
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Stability Healthcare does not discriminate on the basis of any legal-protected category and considers applicants for all positions without regard to race, color, religion, creed, national origin, age, disability, veteran status, gender and sexual orientation. You must fully and accurately complete the Application for employment. Incomplete applications will not be considered. Stability HealthCare may use the information given in the application to verify the applicant's previous employment. The staffing agency you are applying to conducts criminal record checks. Failure to divulge complete information will disqualify you from employment. However, conviction will not necessarily disqualify an applicant from employment. I understand that, if any of the above licensing questions are answered yes, that Stability HealthCare has the right to deny this application. I hereby certify that my answers appearing on this application are true. I understand that if any material information given in this application is found to be incorrect or incomplete, it may be grounds for immediate termination at the sole discretion of Stability HealthCare. I give Stability HealthCare the right to contact my previous employers for verification purposes per your consent at the time employment verification is needed. I authorize Stability HealthCare, to release any medical information required for employment to their client facilities pending clients need in the interview process and to start any employment. I understand that this information is scanned and posted on a secured web-site that is accessible to their client facilities and other affiliates of Stability HealthCare. I understand that this application is not a contract of employment. I also understand and agree that, if hired; my employment would not be for a definite period and could be, regardless of the date of payment of my wages and salary, terminated at any time without any prior notice, with or without any reason. In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, education, education background, and/or criminal history. The selection of this terms and condition box shall have the same force and effect as my written signature.